Baseline metabolic tumor volume (MTV) is a promising prognostic marker in diffuse large B-cell lymphoma (DLBCL). We assessed the prognostic value of 4 novel metabolic risk scores in a real-life DLBCL cohort and compared them with the revised international prognostic index (IPI). Methods: We included a consecutive series of untreated DLBCL, not otherwise specified cases that were diagnosed in our hospital from 2008 to 2021 with available baseline [¹⁸F]FDG PET/CT. Clinical data were collected retrospectively, including the individual components of the revised IPI. MTV and other radiomic features, including lesion dissemination and tumor volume surface ratio, were calculated. Four novel metabolic risk scores including the international metabolic prognostic index (IMPI), the MTV/World Health Organization performance status, the MTV/standardized maximum distance, and clinical PET models were used to calculate the risk of progression using predefined cutoffs. Survival outcomes considered were 3-y progression free survival (PFS), 3-y time to progression (TTP), and 3-y overall survival (OS). The Harrell C-index was used to assess the discriminative performance of the risk scores. A multivariable model was built. Results: We included 355 DLBCL, not otherwise specified cases with a median MTV of 219 cm³ (range, 0–5,656 cm³). The IMPI had the highest C-index for 3-y PFS, 3-y TTP, and 3-y OS among the 4 metabolic risk scores (0.674, 0.696, and 0.677, respectively). For the 3-y TTP, the IMPI outperformed the strongest clinical risk score, the IPI, although the difference in the Harrell C-indices was small (0.696 vs. 0.693). Regarding the 3-y PFS and 3-y OS, the IPI has the highest C-index of all risk scores (0.696 and 0.693). The IMPI, the MTV/World Health Organization performance status, and the IPI score can recognize a poor risk group with a 3-y OS below 50% (43%, 32%, and 39%, respectively). In multivariable analysis, the IMPI remains an independent prognostic factor (P = 0.0089; hazard ratio, 1.207; 95% CI, 1.048–1.389). MTV and standardized maximum distance have the strongest prognostic values when used as a continuous variable. The tumor volume surface ratio has no significant prognostic value in our analysis. Conclusion: The IMPI has the strongest prognostic performance compared with the other 3 novel metabolic risk scores. However, in our real-world dataset, the IMPI could not replace the IPI, and further prospective trials are needed to compare their performance.

基线代谢肿瘤体积 （MTV） 是弥漫性大 B 细胞淋巴瘤 （DLBCL） 的一个有前途的预后标志物。我们评估了 4 个新代谢风险评分在真实 DLBCL 队列中的预后价值，并将其与修订后的国际预后指数 （IPI） 进行了比较。方法：我们纳入了 2008 年至 2021 年在我们医院诊断的一系列连续未经治疗的 DLBCL、未另行说明的病例，这些病例具有可用的基线 [¹⁸F]FDG PET/CT。回顾性收集临床数据，包括修订后的 IPI 的各个组成部分。计算 MTV 和其他放射组学特征，包括病灶播散和肿瘤体积表面比值。使用四种新的代谢风险评分，包括国际代谢预后指数 （IMPI） 、 MTV /世界卫生组织体能状态、 MTV /标准化最大距离和临床 PET 模型，使用预定义的临界值计算进展风险。考虑的生存结局为 3 年无进展生存期 （PFS） 、 3 年进展时间 （TTP） 和 3 年总生存期 （OS）。Harrell C 指数用于评估风险评分的判别性能。构建了一个多变量模型。结果：我们纳入了 355 例 DLBCL，未另行说明的病例，中位 MTV 为 219 cm³ （范围，0-5,656 cm³）。在 4 个代谢风险评分中，IMPI 的 3-y PFS 、 3-y TTP 和 3-y OS 的 C 指数最高 （分别为 0.674 、 0.696 和 0.677）。对于 3 年 TTP，IMPI 的表现优于最强的临床风险评分 IPI，尽管 Harrell C 指数的差异很小（0.696 对 0.693）。关于 3 年 PFS 和 3 年 OS，IPI 在所有风险评分中具有最高的 C 指数（0.696 和 0.693）。 IMPI、MTV/世界卫生组织绩效状态和 IPI 评分可以识别 3-y OS 低于 50% 的不良风险组（分别为 43%、32% 和 39%）。在多变量分析中，IMPI 仍然是一个独立的预后因素 （P = 0.0089;风险比，1.207;95% CI，1.048-1.389）。当用作连续变量时，MTV 和标准化最大距离具有最强的预后值。在我们的分析中，肿瘤体积表面比值没有显着的预后价值。结论：与其他 3 个新的代谢风险评分相比，IMPI 具有最强的预后表现。然而，在我们的真实数据集中，IMPI 无法取代 IPI，需要进一步的前瞻性试验来比较它们的性能。